The client, Jane, was diagnosed with Generalized Anxiety Disorder in 2011 at the age of 35. She and her husband had moved to another town where she had no friends, and the isolation resulted in anxiety that made her see new GP. This anxiety was characterized by feeling tense and unable to relax, insomnia, excessive worry about her health, panic attacks, and being easily irritable. At an intellectual level, she knew the feelings were irrational, but the anxiousness could not allow her to concentrate and reason Pawluk & Koerner 2016). She felt trapped and powerless, but she said her GP her some interest in the anxiety and depression and was beneficial.
The client explains that she had suffered symptoms of anxiety her entire life and the full diagnosis in 2011 was a relief to her. At a young age, her family members and GPs labeled her as a panicky, unsettled, and restless teenager, and now believe that the condition was generalized anxiety disorder that could be controlled and treated if detected early enough (Zhihui, Hui Chen, & Ruiming, 2015). She now claims that labeling a patient with a condition may be wrong, but it somehow helped her realize that she was suffering from a disease not just some wild flight of fancy.
According to the client, both her mother and grandmother exhibited symptoms of anxiety, and therefore she might have learned to anxious, but she feels Generalized Anxiety Disorder must have been inherited. Apart from hanging GAD, the patient suffers from anxiety about her health and general illness; a challenge she has experienced from for the last five years. Both her parents suffered some serious illness but neither of them coped well, there was always the fear of the future. She argues that she must have learned anxiety from that point; fearing the parents died.
In general, people suffering from generalized anxiety disorder experience a lot of panics and worry about some events in their lives. The victims fear to a level that can interfere with some normal operations in their normal life such as sleep, and the condition is characterized by some symptoms that such as feeling tired, nausea, and headache (Zhihui et al., 2015). These symptoms are not limited to generalized anxiety disorder and therefore should be monitored closely to ascertain that presence of the condition. It should be noted that the disease is easily managed if detected an early stage before it affects the day to day activities of the victim.
Studies have shown that many people in the United States suffer from this condition, a figure in the range of 6.8 million adults; with women as twice as me. This condition exhibits a gradual development mostly from childhood to middle age. Some research works have shown evidence that hormones play some role in the manifestation of the situation and that is why the disease reaches its peak at middle age but vanishes as the victim’s age advances (Whitmore, Spoon, & Ollendick 2014). Some of the accompaniments of generalized anxiety disorder include depression and substance abuse. It should be noted that generalize anxiety disorder gets treated with some medication or cognitive-behavioral therapy; however, the opportunistic conditions must also be treated or managed using recommended procedures.
People experience anxiety on a daily basis regarding various aspects of life such as financial status, health problems, and relationship issues (Whisman, Robustelli, & Labrecque, 2018). When it comes to generalized anxiety disorder (GAD), the worry and panic become more than the normal as the victims experience severe tension, fear, and panic without any form of provocation. The victims of this condition experience excessive worry about finances, health, relationship, and work. The individuals suffering from this condition sometimes get depressed by anticipating some challenges or by fearing to face a task ahead of them. Such people are always restless and find it difficult falling asleep, and the condition is characterized by some physical symptoms like headaches, sweating, feeling lightheaded, irritability, trembling and sometimes feel out of breath.
Just like other chronic diseases like heart disease, generalized anxiety disorder is caused by a combination of factors such as behavioral, genetic, and developmental factors. Scientists through brain imaging technologies and neurochemical techniques have indicated that there are networks of interacting structures in the brain that are believed to be the cause of general anxiety disorder. More in-depth research on the amygdala, the part that links the part that processes the incoming sensory signals and the section interprets signals shows that if the link triggers fear as a response, the individual can develop GAD (Whisman, Robustelli, & Labrecque, 2018). The specialists argue that if this part of brain stores a lot of bad memories, the amygdala may trigger fear as a response even in circumstances that do not require fear; frequent miscommunication of that type may lead to the development of generalized anxiety disorder. More studies are going on in this area to get an apparent cause of the condition; a move that may shade more light on the methods of managing and controlling the condition.
Valbak (2018) explained that it is believed that by learning the circuitry of the brain in details, the scientists may be able to create a method of influencing the part of the brain in charge of thinking. By controlling this part of the brain, specialists would be able to reduce the rate at which amygdala triggers fear as response hence putting anxiety within conscious control. The new findings regarding the production of new brain cells within the entire life of an individual indicate that in future the specialists may find a way of inducing development of new neurons in the hippocampus of the victims of generalized anxiety disorder.
Based on studies carried out on twins indicated that some genes have some influence on the development of the condition of adverse anxiety. The studies further show that childhood experiences also play some role in the disorder (Thorisdottir, Tryggvadottir, Saevarsson, & Bjornsson 2018). Even though there are no environmental factors associated with this disorder, children who experience extreme life experiences, overprotection from parents or reckless parents, exhibit generalized anxiety disorder at some stage in their life. The primary research in this area currently focuses on how the genetic factors interact with experience to cause this extreme anxiety among individuals. A breakthrough in this area is believed to lead to the formulation of methods of prevention and treatment of the condition.
The choice of management and treatment method of this condition depends on the particular anxiety disorder and the preference of both the patient and the doctor. Treatment consists of medication and or some specific psychotherapy (Spence, Zubrick, & Lawrence 2018). For any treatment to take place, the patient must undergo some thorough diagnosis to ascertain if the present symptoms are for an anxiety disorder or not, what other diseases may be present and if there are other opportunistic conditions coexist simultaneously. The process of identifying the present disorders and other coexisting health challenges before the treatment process helps the medical practitioner to formulate management and treatment methods since each disorder is treated differently.
Some patients had experienced some treatment for the condition earlier, and such information must be revealed to the doctor in advance before the current treatment process begins. The doctor needs to know the type of treatment the patient received earlier if it was medical and or psychotherapy (Reeves, Fisher, Newman, & Granger 2016). In case the patient was subjected to treatment, the current doctor needs to know the drugs used, the dosage, how long the treatment lasted, and if there was any improvement. If it was psychotherapy, the patient needs to share details such as how often he or she attended the sessions and if there were any improvement. The doctor also needs to know the patient’s feeling about the previous management and treatment process; if he or she liked or disliked the procedure. This information is essential to get the patient’s perception of the treatment given that most people do feel that they have failed or the process failed them when the intended treatment is not achieved.
As illustrated by Pawluk and Koerner(2016), this case, the client had undergone some treatment before the current which included both medication and psychotherapy. From the information she shared, the medication method was not successful given that she refused to take antidepressant drugs given to her; it is said that she was just against drugs as she felt they could not improve her condition. However, it was clear that she liked and enjoyed psychotherapy sessions which helped her reduce the anxiety to some manageable level. Her love for psychotherapy was evident given that she could walk long distance three times a week to attend the sessions.
It should be noted that when a patient undergoes management and treatment for anxiety disorder, both the health professional and the patient work as a team and the success of the process depends on cooperation between them. The cordial relationship helps the two participants come up with methods that work best for the client such that if one method fails, there are chances that the other one will be successful. Several trials and mutual understanding between the two helps the patient avoid the feeling that the method has failed him or her, or that he or she has failed the process. With the ongoing research in this area, it is believed that there will be a breakthrough in formulating some successful interventions for generalized anxiety disorder (Mohlman, Eldreth, Price, Staples, & Hanson 2017). Given that my client enjoyed working with psychotherapy in the previous treatment process, we decided to employ the process as a start.
Psychotherapy entails having conversations with trained health professionals to help the anxiety disorder patient learn how to cope with the condition. Such trained mental health professionals may include a social worker, psychiatrist, counselor, and psychologist.
Cognitive-Behavioral and Behavioral Therapy
This is a therapy aimed at moderating the way a patient perceive and respond to the events that may trigger fear and anxiety. The cognitive part of the therapy assists the patients suppresses the perceptions that encourage fear. Based on this session, the patient can detect any form of activity that may encourage fear and anxiety and act accordingly by either ignoring or taking a stronger stand (MacDonald, Pawluk, Koerner, & Goodwill 2015). The behavioral sessions help the patient know how to react to events that provoke fear and anxiety. The Cognitive-behavioral therapy (CBT) in general helps patients have some idea and avoid situations that may trigger fear and anxiety. The process goes on to equip the patient with the right mentality to deal with such situations in case he or she already encounters them.
The application of Cognitive-behavioral therapy (CBT) in Jane’s case aimed at helping her learn that her panic was not precisely a reality and that the fear of other people watching and judging her was just some kind of illusion. By making a diagnosis on Jane, it was revealed that she had a social phobia that made her believe that other people were always following her. The cognitive sessions would enable her to be ready to confront the fear while the behavioral therapy sessions assist her in handling her emotions in public places. According to Landreville, Gosselin, Grenier, Hudon, & Lorrain (2016), one point encouraged in the therapy is the idea of taking a deep breath as a relaxation aid. It should be noted that when an individual is ready to confront her fears, she is better to train her to use exposure techniques to desensitize herself to circumstances that trigger her anxieties.
It is planned that when Jan undergoes the Cognitive-behavioral therapy (CBT), she will be subjected to exposure only when she is ready. The process is scheduled to take place gradually only with her permission; she is expected to work with the medical team determine the speed of the process and how much she can handle at a time (Koerner, Mejia, & Kusec 2017). It should be noted that one of the main side effects of therapy is discomfort which can bring a bad attitude towards the process and harm its success. With this reality in mind, we are going to direct the therapy sessions to specific anxieties that affect Jane.
Cognitive-behavioral therapy (CBT) process is expected to last for about three months. Jane may be included in a group of other patients as long as their problems are the same and they are comfortable with each other in the group (Kariagina 2017). We recommend Jane be placed in a group of other patients as this would be an advantage in solving her social phobia. She is expected to handle some assignments that will be given to her The homework would enable the medical practitioner to evaluate her attitude towards the sessions; her attitude and perception towards the process are critical as it influences the level of success the therapy would achieve.
It should be noted that the impacts of therapy in solving anxiety disorder have long-lasting effects than that of medication (Jakubovski, & Bloch 2016). The skills acquired, and the behavioral change can shape even other events in an individual’s life other than just health conditions. Treating anxiety disorder may be challenging in that the condition may resurface even after it had been treated and the victims are advised to take it just like any other disease that may re-infect patient after treatment (Hicks & Snyder 2018). The therapy skills, knowledge, and experience should enable the patient to control the anxiety and seek treatment just as in the previous infection. As mentioned earlier, therapy is given the priority here given that Jane seems to be comfortable with it. However, if therapy fails to yield the intended results, we may give medication a fair trial as a method of treatment. According to plans in place, if such a situation arises, the following medication processes may take place.
Antidepressants
Some of the medications that are lined for her in case therapy fails to include the ones that were initially used to treat depression but were later found to be effective in treating anxiety disorder. Specialists have realized that these medications take several weeks before the symptoms of anxiety disorder start fading; we, therefore, plan to encourage Jane to continue taking them even if she feels discouraged. Hara et al. (2015) explains that some of the latest antidepressants scientists have come up with that are believed to treat this condition include selective reuptake inhibitors (SSRIs). These medications need time to act on the chemical messenger in the brain called serotonin.
Selective reuptake inhibitors (SSRIs) are believed to have fewer side effects as compared to older antidepressants. However, some of the known side effects are nausea and sexual dysfunction when using the medications, but they disappear after some time (Fracalanza, Koerner, Deschênes, & Dugas 2014). The challenges can be avoided by adjusting the dosage or switching the selective reuptake inhibitors (SSRIs) in use. We expect Jane to discuss with the doctor the side effects and any other challenge she experiences due to the medications to make the specialist know when to adjust the dosage or switch the medication. Apart from selective reuptake inhibitors (SSRIs), Venlafaxine is another drug capable of treating generalized anxiety disorder (Elmquist, Shorey, Anderson, & Stuart 2016). Another antidepressant called tricycline has been in use longer than selective reuptake inhibitors (SSRIs), but specialists prefer using the newer medication. Tricycline is accused of various side effects such as weight gain, dizziness, and dry mouth among the users. We may consider using imipramine, an example of tricycline, to suppress co-occurring anxiety and depression
We have recommended high-potency benzodiazepine as a fast way of removing the symptoms of the anxiety disorder since it has few side effects like drowsiness (Fialho et al. 2016). This agreement was reached given that it is believed that Jane can develop tolerance easily. The fact that this medication has fewer side effects that can easily be tolerated; it is planned that the dosage will be increased gradually over the period to fasten the process. Jane has no history of alcohol and other drug abuse, and this makes her a good candidate for this type of medication (Degenhardt et al 2015). When a patient stops using this drug abruptly, he or she may experience withdrawal side effects and resumption of anxiety. It should be indicated that some health practitioners have in the recent past reduced the usage of this drug due to its side effects and sometimes use it inadequately even in areas where it is the best drug.
We plan to use Alprazolam in managing and possible treatment of panic disorder while social phobia and generalized anxiety disorder may be treated using Clonazepam (Klonopin). Another possible medication in treating generalized anxiety disorder may include Buspirone, a new antianxiety that belongs to the family of drugs known as azipirones which must be taken for at least two weeks for effects to be felt (Dar & Iqbal, 2015). This drug is useful, but it exhibits nausea, dizziness, and headaches as possible side effects.
If the above-mentioned medications fail, we may use Beta-blockers like propanolol. This drug is used in heart-related conditions but is also helpful in managing and treating social phobia and anxiety like the one experienced by Jane. Beta-Blockers are also useful in preventing heart pounding, shaking hands and other physical symptoms when a feared but a must situation is scheduled (Altunoz, Bastug, & Ozel-Kizil, 2018). It is believed that with the above-recommended treatments involving therapy and medication, Jane’s generalized anxiety disorder will be managed and finally treated.
Conclusion
For every sick patient, there is a need for proper primary care aimed at ensuring they achieve their original health status. However, the effective treatment process requires the support of family and friends. In full support from the family, it is easier to achieve the health goals as guided by the relevant healthcare provider.
References
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Zhihui, Y., Hui, C., Jiali, D., & Ruiming, W. (2015). Personality and Worry: The Role of Intolerance of Uncertainty. Social Behavior & Personality: An International Journal, 43(10), 1607–1616. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=111059562&site=ehost-live
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